Pain Syndromes: Causes, Symptoms, and Treatments

Complex Regional Pain Syndrome (CRPS)
CRPS is still a poorly understood pain condition. In the past it was called Sudeck’s Atrophy, causalgia or reflex sympathetic dystrophy (RSD). Complex Regional Pain Syndrome is now the accepted name for this condition. There are 2 types: type 1 where there is not a specific local nerve injury identifiable and type 2 due to a specific local nerve injury.

The classic symptoms of CRPS are pain in a local area e.g., foot, leg or hand, accompanied by swelling, colour change and tenderness to touch, out of proportion to what structural pathology can explain. Alterations to hair growth or nails can also occur in the area. These changes can follow an injury or surgery, but sometimes even minor trauma can set off the cascade of pain and swelling.

Treatment for CRPS has a much better outcome if the condition is diagnosed early and treatment commences without delay. Treatments provided by a multidisciplinary team have the best outcome.

The mainstay for CRPS treatment is functional rehabilitation. That means you are encouraged to use the affected limb in a way that you normally would use it. It is important to realise that you will not damage the affected limb by using it, even if it hurts.

Medications can help to modulate CRPS symptoms and to increase capacity to perform rehabilitation. Common medications used are neuroleptic medications e.g., Pregabalin and Gabapentin or anti-depressants such as Amitriptyline.

Psychological therapies play an important role in the management of CRPS. Cognitive behavioural therapy and mirror therapy have shown promising results.

Minimally invasive interventions can improve CRPS symptoms and potentiate rehabilitation. Sympathetic nerve blocks with local anaesthetic or longer-term block with pulsed radiofrequency stimulation can be very effective to reduce the vascular symptoms of CRPS (swelling, colour change) and to reduce pain.

Advanced treatments include spinal cord stimulation. To improve CRPS symptoms the leads are positioned close to the dorsal root ganglion (DRG), the nerve centre of a peripheral nerve.